Nurses with Doctorates

While most of us are still sound asleep, J. Lynn Prosser is on her way to the Severstal Wheeling coke plant in Follansbee, W.V., where her shift as plant nurse begins at 6 a.m.

From there, she heads over to the ArcelorMittal plant before moving on to Paris Preferred Family Health – her private practice – where she sometimes stays late into the evening.

“I want to serve the working people,” she says.“A working mom can't take two hours in the middle of the day to go to the doctor.”

Prosser is a student in the Doctor of Nursing Practice degree program at Robert Morris University. Nurse practitioners are advanced practice nurses certified to diagnose and manage patients, though in Pennsylvania they must have a physician collaborator. The D.N.P. is an advanced-level practice degree focusing on the clinical aspects of nursing, rather than academic research. RMU’s first 27 recipients of the D.N.P. were presented with their doctorates last month at commencement; 64 more, including Prosser, will get their degrees next year.

In 2007, the Pennsylvania State Board of Nursing approved the university’s “B.S.N. to D.N.P.” program, making Robert Morris University the first institution in the state to offer a nurse practitioner program at the doctoral level. As nurses’ responsibilities continue to grow and become more complex, a new type of nursing leader is needed – one with doctoral-level training who can work with an interdisciplinary team to deliver evidence-based, patient-centered care. With the baby boomer generation entering its golden years, the demand for additional health care providers, especially nurses with advanced practice degrees, will be in high demand.

The D.N.P. program is designed to prepare advanced-practice nurses to apply nursing science and clinical reasoning at the highest level. Utilizing expert communication and leadership skills, D.N.P. students are taught to integrate theory, clinical inquiry, information technology, and evidence-based practice for clinical decision-making and quality patient care.

Prosser, in her final year of doctoral studies at RMU, began as a medical assistant and spent more than 18 years as an Army nurse. While in the service, she earned her bachelor's degree from Excelsior College and her master's degree from the Franciscan University of Steubenville.

Working in the plants, Prosser sees lots of patients with injuries to their backs, knees, and shoulders. Her capstone project for the DNP is on musculoskeletal injuries. “I’m trying to determine if pre-shift stretching can help prevent injury,” she says. Prosser also treats spine and neck injuries and orders MRIs when needed. “I see a lot of cuts and lacerations from the steel too,” she adds. She analyzes worksites to make sure they are safe, holds regular health fairs, and, at Severstal, does regular “coke physicals” to make sure workers’ masks are properly filtering the heavy dust from the air they breathe.

Prosser has seen a little bit of everything while working as a plant nurse. One Halloween at the Severstal plant, the staff nurse she was working with was dressed like a witch. An intoxicated pedestrian wandered onto mill property, tripped on some railroad tracks, and was hurt. Plant security brought the man into the clinic, but when he saw the nurse dressed as a witch, he assumed he had died. “He thought he was in hell,” says Prosser. “Every time the nurse tried to approach him, he’d do the sign of the cross.”

She opened her own practice last October and is now serving her community by providing much-needed, patient-centered health care to local residents. “There is a shortage of family physicians now,” she says, “and we're filling that gap.”

Judith Kaufmann, Dr.P.H., is director of the program in the School of Nursing and Heath Sciences. She says the D.N.P. supports the idea of the interdisciplinary team – that no one provider fits all. “We’re looking at how nurse practitioners, nurse anesthetists, clinical specialists, midwives, and so on, can be working with physicians, physical therapists, pharmacists, occupational therapists, speech therapists, and others,” she says. “And everyone is moving to the doctoral level.” One of the reasons that the D.N.P. is so important, she says, is that it enables nurse practitioners to talk the same talkas other people who have learned how to use research and evidence in their decision making. “That way, the nurse practitioners have more of a voice in this whole team approach,” she says.

“The D.N.P. doesn’t change nurse practitioner practice,” says Kaufmann. “Nurse practitioners can’t practice in Pennsylvania without a physician collaborator. What the D.N.P. does, however, is give master’s-prepared nurse practitioners additional education in how to look at current evidence and research and how to evaluate outcomes of their particular practice.”

Before the D.N.P. came about, a master’s degree was required to be an advanced practice nurse. Then in 2004, the American Association of Colleges of Nursing called for raising the level of preparation necessary for advanced nursing practice from a master’s degree to a doctorate.

Some physicians have spoken out against the D.N.P., unhappy with how some practitioners are now being referred to as “doctor” by their patients. Kaufmann defended the D.N.P. in a letter published in The Chronicle of Higher Education: “This is a nursing degree that signifies the highest level of nursing practice, using the best evidence for making patient-care decisions,” she stated. “It is in the best interest of all health-care providers (and patients) that each profession comes to the interdisciplinary table with comparable academic preparation. This degree does not make physicians out ofnurses, nor does it change the nurse-practitioner practice that is outlined by state boards of nursing.”

Joan Romboli, a family nurse practitioner from southern New Hampshire, runs her own family health care practice and has over 6,000 patients. She had been out of school for 13 years when she found about the university’s D.N.P. program. “When I read what RMU had to offer, I was intrigued,” she says. “I always knew that I wanted to further my education, but a research doctorate never seemed like a right fit for me. After all, I was a clinician.”

Romboli liked that the program enabled her to work side-byside with other professionals and that its courses were clinical in focus. Her biggest surprise came with the level of education she received at RMU. “Coming from just north of Boston, I certainly knew high-caliber education,” she says. “Within the first few hours of classes at RMU, I knew I had chosen the right place.”

Romboli completed a study sponsored by the Swiss drug maker Novartis looking at patients with high blood pressure under the care of independentnurse practitioners in New Hampshire. The study suggested that while nurse practitioners prescribed medication in lesser amounts for such patients than M.D.’s typically would, they were more likely to prescribe lifestyle changes, so their patients actuallywere just as likely to succeed in lowering their blood pressure. “Now, with the challenges of this nation's health care environment,” says Romboli, “we’re starting to realize that the highest level of knowledge and clinical expertise is required to improve the health of clients.”

Ann Linguiti Pron is a pediatric nurse practitioner for PHMC Health Connections in north Philadelphia and at the Children’s Health Center in Abington, Pa. “I really like working with kids,” says Pron. “I don’t like giving them shots, but otherwise I really enjoy it.”

Pron first heard about RMU’s program from a friend who was one of the first students enrolled. At the time, Pron was working as an assistant professor of nursing at Temple University, which was looking to start a program of its own.

The American Association of Colleges of Nursing recently gave Pron its AfterCollege Scholarship, a prestigious award for graduate and undergraduate nursing students who demonstrate strong scholarship and leadership skills. Pron says the scholarship will enable her to expand her teaching focus in order to assist the next generation of advanced practice nurses. “The main reason I wanted to pursue the D.N.P. was to stay involved with nurse practitioner education,” says Pron. “A Ph.D. didn’t appeal to me,” she says. “I liked the D.N.P. because it was practice focused and clinical.”

She liked how RMU’s program had everything rolled into one, and the flexibility was compatible with her busy work schedule. Plus, she liked the combination of in-class and online courses, which allowed her to work at her own pace. “It really allows you to get to know the other students,” she says. “We e-mail each other and talk on the phone, and it’s nice to have a group of people that you can identify with. And Dr. Kaufmann is a dynamo. She really stays connected with us.”

The response to RMU’s program has been overwhelming. Each year the school has accepted more students than anticipated, and there is currently a waiting list. One of the challenges Kaufmann sees in the development of the D.N.P. is turning clinicians into academic scholars. “They are experts at what they do and how they see patients,” she says, “but they have very little experience with the research process, with scientific writing, with the precision for disseminating results. The amount of mentoring that they require in order to do quality studies… It takes a lot of faculty.

“That said, it’s probably the most exciting thing I’ve ever done – to watch them become clinical scholars,” says Kaufmann. “They’re primed and ready to take on that role. And to watch the transformation is very, very exciting.”

This spring, 27 doctoral candidates earned the Doctor of Nursing Practice degree, or D.N.P., from Robert Morris University.